Mock Final Exam II Flashcards
Which federal law established the National Practitioner Data Bank (NPDB)?
A) HIPAA
B) Health Care Quality Improvement Act
C) Patient Protection and Affordable Care Act
D) Emergency Medical Treatment and Labor Act
B) Health Care Quality Improvement Act
Which of the following is NOT a required element for peer review immunity under HCQIA?
A) Actions taken in reasonable belief of furthering quality healthcare
B) Reasonable effort to obtain facts
C) Adequate notice and hearing procedures
D) Proof of actual improvement in patient outcomes
D) Proof of actual improvement in patient outcomes
What is the primary purpose of a living will?
A) To provide financial planning for end-of-life care
B) To designate someone to make healthcare decisions
C) To specify treatment preferences when incapacitated
D) To distribute property after death
C) To specify treatment preferences when incapacitated
In which case did the Supreme Court uphold the ACA’s individual mandate as a valid exercise of Congress’s taxing power?
A) King v. Burwell
B) NFIB v. Sebelius
C) Cruzan v. Director, Missouri Department of Health
D) Burwell v. Hobby Lobby
B) NFIB v. Sebelius
What legal principle prevents relitigation of issues that have already been decided in a previous case between the same parties?
A) Stare decisis
B) Res judicata
C) Res ipsa loquitur
D) Due process
B) Res judicata
Which doctrine holds that “the thing speaks for itself” in negligence cases where the injury wouldn’t occur without negligence?
A) Respondeat superior
B) Res ipsa loquitur
C) Stare decisis
D) Res judicata
B) Res ipsa loquitur
Compare and contrast the Quinlan case with Cruzan v. Director, Missouri Department of Health. How did these landmark decisions shape the legal framework for end-of-life decision making?
In re Quinlan (1976) established a constitutional right to privacy that extended to refusing life-sustaining treatment, allowing Karen’s father as guardian to exercise this right on her behalf. The New Jersey court emphasized the family’s role in decision-making. Cruzan (1990) was the first Supreme Court case on this issue, recognizing a constitutionally protected liberty interest in refusing unwanted treatment but also upholding Missouri’s requirement for “clear and convincing evidence” of the patient’s wishes. While Quinlan focused on privacy rights and family decision-making, Cruzan focused on liberty interests and evidentiary standards.
Together, these cases established that:
1) patients have a right to refuse treatment,
2) this right extends to incompetent patients,
3) states have legitimate interests in protecting life, and
4) advance directives are critical for documenting wishes.
he “captain-of-the-ship” doctrine in healthcare liability:
A) Has been strengthened by recent court decisions
B) Makes hospital administrators liable for all decisions
C) Has largely been abandoned in favor of recognizing the team approach to healthcare
D) Makes insurance companies the primary liable party
C) Has largely been abandoned in favor of recognizing the team approach to healthcare
Under EMTALA, a hospital is required to do all of the following EXCEPT:
A) Provide an appropriate medical screening examination
B) Stabilize emergency medical conditions before transfer
C) Accept all transfers from other facilities
D) Maintain a list of on-call physicians
C) Accept all transfers from other facilities
Which case established that a hospital can be liable for negligently granting privileges to an incompetent physician?
A) Darling v. Charleston Community Memorial Hospital
B) Johnson v. Misericordia Community Hospital
C) Thompson v. Nason Hospital
D) Bing v. Thunig
B) Johnson v. Misericordia Community Hospital
Evaluate the evolution from the “locality rule” to a national standard of care in medical malpractice. What factors drove this change and how does it impact rural healthcare providers?
The locality rule originally limited the standard of care to physicians in the same or similar communities, recognizing geographic disparities in resources and training.
The evolution to a national standard was driven by:
1) standardization of medical education and board certification,
2) improved communication and access to information,
3) nationwide practice guidelines, and
4) recognition that geography shouldn’t determine quality of care.
Rural providers now face challenges including: being held to standards developed in resource-rich environments, difficulty recruiting specialists, limited access to cutting-edge technology, and potential increased liability exposure.
Courts have addressed this through the “justifiable circumstances” defense, acknowledging that rural providers aren’t responsible when necessary resources are unavailable despite reasonable efforts to obtain them.
Under the doctrine of apparent agency, hospitals may be liable for independent contractors when:
A) The contractor carries malpractice insurance
B) Patients reasonably believe the contractor is a hospital employee
C) The hospital has more than 100 beds
D) The contractor has privileges at multiple facilities
B) Patients reasonably believe the contractor is a hospital employee
What legal doctrine makes an employer liable for the negligent acts of employees performed within the scope of employment?
A) Respondeat superior
B) Corporate negligence
C) Personal jurisdiction
D) Informed consent
A) Respondeat superior
In the case Schloendorff v. Society of New York Hospital, the court established:
A) The duty to provide emergency care
B) The right to determine what happens to one’s body
C) The standard for hospital liability
D) The requirement for written consent
B) The right to determine what happens to one’s body
Explain how the Ostrowski v. Azzara case changed how courts view patient conduct in contributory negligence claims. What implications does this have for healthcare providers treating patients with health-harming behaviors?
Ostrowski v. Azzara established that patient pre-treatment negligence (like smoking despite diabetes) should be evaluated separately from post-treatment conduct. The court recognized that patients’ harmful habits may be the very reason they need medical care, and that addiction and socioeconomic factors complicate behavioral change.
Healthcare providers must:
1) document thorough counseling about behavioral modifications,
2) avoid discriminating against patients with harmful habits,
3) recognize that recovery depends on both provider care and patient cooperation, and
4) understand that while patients bear responsibility for post-treatment compliance, their pre-treatment lifestyle typically doesn’t reduce provider liability.
This creates a balanced approach that holds providers to professional standards while acknowledging patients’ responsibility in their recovery.
Which of the following is NOT a type of Alternative Dispute Resolution in healthcare?
A) Arbitration
B) Mediation
C) Statutory intervention
D) Negotiation
C) Statutory intervention
What does the “reasonable patient standard” for informed consent require physicians to disclose?
A) Only what other physicians typically disclose
B) All possible risks, regardless of likelihood
C) Information a reasonable patient would consider material to their decision
D) Only information contained in standardized consent forms
C) Information a reasonable patient would consider material to their decision
A strict liability claim in healthcare typically applies to:
A) Services provided by healthcare professionals
B) Defective medical products or devices
C) Administrative decisions by hospital executives
D) Policy decisions by insurance companies
B) Defective medical products or devices
In Tarasoff v. Regents, the court established that healthcare providers have a duty to:
A) Report all mental health conditions to authorities
B) Warn identifiable third parties of threats
C) Prevent all patient violence
D) Breech confidentiality in all dangerous situations
B) Warn identifiable third parties of threats
Analyze how ERISA preemption affects malpractice claims against managed care organizations. What has been described as the “tangled ERISA regime” and how does it impact patient remedies?
RISA preemption creates a bifurcated system where state law claims against MCOs for coverage decisions are preempted when employee benefit plans are involved, while direct care decisions may still be subject to state law.
The “tangled ERISA regime” refers to this complex framework where:
1) patients with employer-based plans have limited remedies (typically only the cost of denied benefits, not consequential damages),
2) identical medical decisions may face different liability standards depending on plan type, and
3) courts struggle to distinguish between “quality of care” and “benefits administration” decisions.
This regime impacts patients by restricting meaningful compensation for injuries resulting from improper coverage denials, creating inconsistent protections, and shifting liability disproportionately to providers even when MCO policies influenced care decisions. Despite criticism, Congress has not clarified or reformed this system.
What is “corporate practice of medicine” prohibition?
A) The restriction on physicians practicing in multiple states
B) Laws preventing corporations from directly employing physicians
C) Rules against physicians forming their own corporations
D) Regulations preventing hospitals from advertising
B) Laws preventing corporations from directly employing physicians
Which of the following is NOT a requirement for EMTALA compliance?
A) Appropriate medical screening for emergency conditions
B) Treatment to stabilize emergency medical conditions
C) Following proper transfer procedures
D) Providing ongoing care until full recovery
D) Providing ongoing care until full recovery
According to Ybarra v. Spangard, res ipsa loquitur can be applied to:
A) Multiple defendants who had control over the patient
B) Only the surgeon who performed the procedure
C) Hospital administrators exclusively
D) Third-party payers who denied coverage
A) Multiple defendants who had control over the patient
Compare how courts have treated wrongful birth versus wrongful life claims. Why have most courts been reluctant to recognize wrongful life claims despite acknowledging wrongful birth?
Courts have generally recognized wrongful birth claims (brought by parents) while rejecting wrongful life claims (brought on behalf of children). Most courts accept wrongful birth because damages are calculable based on extraordinary costs of raising a child with disabilities that parents would have avoided with proper information.
Courts reject wrongful life claims because they:
1) struggle philosophically with the notion that non-existence is preferable to life with disability,
2) find it impossible to calculate damages comparing existence with non-existence,
3) worry about devaluing lives of disabled persons, and
4) fear expanding liability beyond reasonable bounds.
The few states recognizing wrongful life typically limit recovery to special damages like medical costs rather than general damages for “being born.” This distinction reflects courts’ comfort with compensating parents’ economic losses while avoiding philosophical determinations about the value of impaired life.
In Hawkins v. McGee, how were damages calculated in the breach of warranty case?
A) Based on pain and suffering
B) Based on difference between promised result and actual result
C) Based on punitive damages
D) Based on lost wages
B) Based on difference between promised result and actual result
Which case established that a hospital has direct corporate liability for the quality of care provided within its walls?
A) Johnson v. Misericordia Community Hospital
B) Darling v. Charleston Community Memorial Hospital
C) Washington v. Washington Hospital Center
D) Thompson v. Nason Hospital
B) Darling v. Charleston Community Memorial Hospital
The Hill-Burton Act required hospitals receiving federal funding to:
A) Provide emergency care only
B) Have physicians on staff 24 hours a day
C) Provide uncompensated care and community service
D) Accept all insurance plans
C) Provide uncompensated care and community service
How did the Washington v. Washington Hospital Center case impact the standard of care regarding new medical technologies? What implications does this have for hospital administrators managing the acquisition of emerging medical equipment?
Washington v. Washington Hospital Center established that hospitals can be held to standards based on emerging technologies even without unanimous expert testimony, finding that carbon dioxide monitors had become standard equipment during anesthesia.
This impacts hospital administrators by:
1) creating potential liability during the “zone of transition” between older practices and emerging technologies,
2) requiring ongoing evaluation of new equipment against potential patient safety benefits,
3) necessitating systems to identify when new technologies are becoming standard, and
4) balancing financial constraints against potential liability.
Administrators must develop structured processes for technology assessment, maintain awareness of evolving standards in comparable facilities, and document decision-making rationales for adopting or delaying implementation of new technologies to demonstrate reasonable consideration of patient safety.
What is the primary focus of the Patient Self-Determination Act?
A) Requiring hospitals to perform specific procedures
B) Informing patients of their rights regarding advance directives
C) Setting standards for physician licensing
D) Establishing billing procedures
B) Informing patients of their rights regarding advance directives
Which statement about exculpatory contracts in healthcare is most accurate?
A) They are generally enforceable if written clearly
B) They are invalid as contrary to public policy in most healthcare contexts
C) They are valid only for experimental procedures
D) They are enforceable only for minor procedures
B) They are invalid as contrary to public policy in most healthcare contexts
What constitutes a “never event” in healthcare?
A) A condition that cannot be cured
B) A serious, preventable adverse event that should never occur
C) A procedure that is experimental
D) A treatment that insurance will never cover
B) A serious, preventable adverse event that should never occur
In Cobbs v. Grant, what standard for informed consent was established?
A) Professional community standard
B) Reasonable patient standard
C) Subjective patient standard
D) Strict liability standard
B) Reasonable patient standard
Discuss the legal implications of the Marsh v. Arnot Ogden Medical Center case regarding medication errors. What systems-level approaches should healthcare facilities implement to prevent similar incidents?
Marsh v. Arnot Ogden Medical Center established that hospitals failing to implement medication error prevention systems or educational programs could face punitive damages beyond compensatory damages.
Healthcare facilities should implement:
1) Computerized provider order entry (CPOE) systems with decision support to prevent transcription errors and flag potential interactions,
2) Closed-loop medication administration systems with barcode verification,
3) Formal error reporting systems with non-punitive cultures that encourage disclosure,
4) Structured root cause analysis procedures for all medication errors,
5) Regular staff education on high-alert medications, and
6) Clear documentation protocols including standardized abbreviations and dose designations.
The case demonstrates that facilities have organizational responsibility beyond individual provider errors, and systemic failures to address known risks can create significant liability exposure.
The legal concept of “foreseeability” is most relevant to which element of negligence?
A) Duty
B) Breach
C) Causation
D) Damages
C) Causation
What is the primary difference between Medicare Part A and Part B?
A) Part A covers outpatient services while Part B covers hospital stays
B) Part A covers hospital insurance while Part B covers physician services
C) Part A is for elderly patients while Part B is for disabled patients
D) Part A is mandatory while Part B is optional
B) Part A covers hospital insurance while Part B covers physician services
What is the “discovery rule” in medical malpractice cases?
A) The requirement that physicians disclose all complications
B) The time limitation for obtaining medical records
C) The rule that the statute of limitations begins when the patient discovers the injury
D) The obligation to reveal all expert witnesses before trial
C) The rule that the statute of limitations begins when the patient discovers the injury
What was the key ruling in In re Baby M regarding surrogacy contracts?
A) Commercial surrogacy contracts are enforceable in all states
B) Traditional surrogacy differs legally from gestational surrogacy
C) Surrogate mothers have no parental rights
D) Surrogacy contracts that involve payment are invalid and unenforceable
D) Surrogacy contracts that involve payment are invalid and unenforceable
Explain how the evolution of legal doctrine from Bing v. Thunig to Darling v. Charleston Community Memorial Hospital transformed hospital liability. What is the modern justification for corporate liability?
Bing v. Thunig (1957) eliminated the distinction between “administrative” and “medical” acts, rejecting hospital immunity for medical acts and establishing that hospitals could be held liable for negligence of employees. Darling (1965) expanded this by creating direct corporate liability for hospitals failing to review and monitor care quality.
This transformation moved from charitable immunity to direct institutional responsibility based on several justifications:
1) hospitals are complex organizations exercising significant control over healthcare delivery,
2) patients select hospitals based on institutional reputation and expect oversight of practitioners,
3) hospitals are better positioned than patients to monitor quality and prevent harm, and
4) hospitals benefit financially from providing care and should bear corresponding responsibility.
The modern justification recognizes that healthcare quality depends on systems and processes beyond individual provider decisions, making institutional accountability essential.
Which case established that competent adults may refuse life-sustaining treatment?
A) Cruzan v. Director, Missouri Department of Health
B) In re Quinlan
C) Vacco v. Quill
D) Washington v. Glucksberg
A) Cruzan v. Director, Missouri Department of Health
What is the significance of Truman v. Thomas regarding informed consent?
A) It extended informed consent to include risks of not undergoing recommended procedures
B) It established that only written consent is valid
C) It created an exception for emergency procedures
D) It established that hospitals, not physicians, are responsible for obtaining consent
A) It extended informed consent to include risks of not undergoing recommended procedures
Under Medicare, what determines whether a hospital admission is considered “inpatient” or “outpatient”?
A) The specific procedure performed
B) The length of the hospital stay
C) The physician’s order and medical necessity
D) The patient’s insurance coverage
C) The physician’s order and medical necessity
Analyze the limitations of Good Samaritan statutes in encouraging emergency assistance. How do these statutes vary between states, and what key factors determine their effectiveness?
Good Samaritan statutes aim to encourage emergency assistance by providing immunity from ordinary negligence claims, but their effectiveness is limited by:
1) variation in who is protected (some states cover only medical professionals, others include laypeople),
2) differing standards of protected conduct (most exempt ordinary negligence but not gross negligence),
3) inconsistent application to different settings (some apply only at accident scenes, others include clinical settings), and
4) limited public awareness of these protections.
Key variations between states include whether: immunity covers only volunteers or also paid providers, pre-existing duty relationships are exempted, immunity extends to AED use, and whether any affirmative duty to assist exists (most states don’t require assistance).
The statutes’ effectiveness depends on clear immunity provisions, broad coverage of rescuers, and public education about protections available.
What is “negligence per se” in healthcare?
A) Negligence that is obvious to any reasonable person
B) Negligence presumed due to violation of a statute
C) Negligence by hospital administrators
D) Negligence involving multiple defendants
B) Negligence presumed due to violation of a statute
Which of the following is NOT a proper method of terminating the physician-patient relationship?
A) Completion of treatment
B) Mutual agreement
C) Patient dismissal of physician
D) Physician withdrawal without notice
D) Physician withdrawal without notice
What was the key holding in the Griswold v. Connecticut case?
A) States cannot prohibit contraception use by married couples
B) Hospitals must provide emergency contraception
C) Pharmacists must dispense contraception regardless of personal beliefs
D) Insurance must cover contraception
A) States cannot prohibit contraception use by married couples
The “mature minor” doctrine refers to:
A) Children who can legally live independently
B) Minors who can consent to their own medical treatment
C) Young adults between 18-21
D) Adolescents who can refuse life-saving treatment
B) Minors who can consent to their own medical treatment
Which healthcare role is most likely to be considered an independent contractor rather than an employee?
A) Staff nurse
B) Hospital CEO
C) Emergency room physician with privileges but no employment contract
D) Hospital cafeteria worker
C) Emergency room physician with privileges but no employment contract
Under the “substituted judgment” standard for incompetent patients, decision makers should:
A) Make decisions based on their own values
B) Determine what the patient would have decided if competent
C) Always choose life-prolonging treatment
D) Defer to physician recommendations
B) Determine what the patient would have decided if competent
What was the significance of Leach v. Drummond regarding physician withdrawal from patient care?
A) Physicians can withdraw from care with proper notice
B) Medical groups may be required to continue care when no alternatives exist
C) Hospitals must provide care regardless of payment
D) Emergency care must be provided without prior consent
B) Medical groups may be required to continue care when no alternatives exist
Discuss the legal and ethical implications of economic credentialing practices. How do courts balance hospital financial interests against medical staff independence?
Economic credentialing (using economic criteria for medical staff privileges) creates tension between hospital financial interests and medical staff independence.
Courts generally uphold hospital discretion regarding privilege decisions but require:
1) adherence to bylaws and fair procedures,
2) non-discriminatory application of criteria,
3) reasonable relationship between requirements and quality patient care, and
4) protection of competitive healthcare markets. The legal implications include potential claims of antitrust violations, interference with physician-patient relationships, and breach of medical staff bylaws.
Ethically, economic credentialing raises concerns about subordinating patient interests to financial considerations, creating conflicts of interest for physicians, and potentially compromising clinical independence.
Courts have generally permitted economic factors in credentialing decisions when reasonably related to organizational efficiency and sustainability, provided patient care quality remains the paramount consideration.
In Davis v. Davis, what issue regarding frozen embryos did the court address?
A) Whether embryos could be used for research
B) Whether embryos could be donated to other couples
C) Disposition of embryos in divorce when parties disagree
D) Whether insurance must cover embryo storage
C) Disposition of embryos in divorce when parties disagree
What legal principle holds that courts generally defer to hospital decisions regarding staff privileges if reasonably related to hospital operations and fairly administered?
A) Corporate negligence
B) Judicial deference
C) Medical autonomy
D) Administrative discretion
B) Judicial deference
What is the significance of EMTALA’s requirement that hospitals maintain a central log?
A) To facilitate billing for emergency services
B) To track patient flow and diagnoses
C) To document compliance with screening and stabilization requirements
D) To coordinate transferring patients to other facilities
C) To document compliance with screening and stabilization requirements
What was established in the Patrick v. Burget case regarding peer review?
A) Peer review activities are always protected from antitrust claims
B) Peer review immunity doesn’t apply to bad faith actions
C) Peer review records are discoverable in all litigation
D) Hospitals have absolute immunity for all peer review decisions
B) Peer review immunity doesn’t apply to bad faith actions
Examine how the “respectable minority principle” in medical malpractice affects innovation in healthcare. How do courts balance protection of physicians following alternative approaches against patient safety concerns?
The respectable minority principle protects physicians who choose treatments recognized by a respectable minority of the profession, even when not the mainstream approach.
Courts balance innovation and safety by requiring that:
1) the alternative approach be recognized by at least some portion of the medical community,
2) the physician follow the standard of care within that minority approach,
3) the treatment decision be based on reasoned medical judgment rather than mere experimentation, and
4) patients be appropriately informed when treatments diverge from majority practice.
This principle encourages medical advancement by providing legal protection for evidence-based innovation while maintaining patient safety through requirements that alternative approaches have some professional acceptance and appropriate informed consent.
Courts generally defer to medical judgment when reasonable physicians disagree about optimal treatment approaches, recognizing that medical progress often begins with minority viewpoints.
What is the primary purpose of the Uniform Parentage Act regarding assisted reproductive technologies?
A) To prohibit commercial surrogacy arrangements
B) To clarify legal parentage in cases involving ART
C) To regulate compensation for egg and sperm donors
D) To establish standards for fertility clinics
B) To clarify legal parentage in cases involving ART
In Roe v. Wade (1973), the Supreme Court established which framework for abortion regulation?
A) Strict scrutiny for all abortion restrictions
B) Undue burden standard throughout pregnancy
C) Trimester framework with different state interests at each stage
D) Complete prohibition until viability
C) Trimester framework with different state interests at each stage
Compare and contrast the constitutional foundations of Roe v. Wade and Planned Parenthood v. Casey. How did the Court’s reasoning evolve between these two landmark cases, and what implications did this have for abortion jurisprudence?
Roe v. Wade grounded abortion rights primarily in the right to privacy found in the “penumbras” of multiple constitutional amendments, particularly the 14th Amendment’s concept of personal liberty and restrictions on state action.
The Court applied strict scrutiny, requiring compelling state interests for regulation. Casey shifted to a liberty interest analysis under the 14th Amendment’s due process clause, focusing more explicitly on women’s autonomy and equal participation in society.
While Casey reaffirmed Roe’s “essential holding” that pre-viability abortion is constitutionally protected, it lowered the standard of review from strict scrutiny to the “undue burden” test, allowing more state regulation so long as it didn’t place substantial obstacles in the path of a woman seeking an abortion.
This evolution reflected a more pragmatic approach that balanced state interests in potential life with women’s liberty interests, creating a more flexible framework that allowed for greater regulation while maintaining constitutional protection.
